Insurance Facts

For information on Medicare coverages and options for supplemental insurance and drug plans, visit www.medicare.gov

A health insurance marketplace is a web- site to buy a health plan. Each state must either have a health insurance marketplace, also called an Exchange, or use the federal one at www.healthcare.gov You use them to compare health plans and find out if you qualify for a subsidy, which is money from the federal government to lower your insur- ance costs. There are sites for people who don’t have insurance from an employer or through Medicare, Medicaid or the military. Under the Affordable Care Act, you cannot be denied health insurance for a pre- existing condition. Before the act was passed, health insurance plans could deny coverage or limit benefits if you had a pre-existing condition. Insurers can no longer refuse to cover anyone because of pre-existing condi- tions or charge them more for a health plan based on their medical condition.

Your health insurance does not run out, no matter how much the insurance company has paid for your care. Lifetime limits are now banned for all new health insurance policies. Insurance companies used to have annual limits and lifetime limits on how much they’d pay for your health care. For example, if you had $100,000 or more of treatment in one year, or more than $1 million over a few years, you hit your limit. After that, you had to pay for 100 percent of your health care.

If your insurance company denies a claim meaning that it refuses to pay its part for services you think are covered – you have the right to appeal, and the health plan is required to respond. If the plan rules against your appeal, you can request an external review of your case. That means someone who’s not connected to your health insur- ance company will decide whether the health plan must pay.

Long-term care insurance covers a range of services and support you may need to meet your personal care needs. Most long- term care is not medical care, but rather assistance with the basic personal tasks of everyday life called Activities of Daily Living as bathing and dressing. Most policies will reimburse you for care given in a variety of places, such as your home, a nursing home, assisted living facility or adult day care center.

Considering long-term care costs is an important part of any long-range financial plan, especially in your 50s and beyond. Waiting until you need care to buy cov- erage is not an option. You won’t qualify for long-term care insurance if you already have a debilitating condition. Most people with long-term care insurance buy it in their mid-50s to mid-60s.